Liu Yunlu, Wang Yang, Zhao Xinyu, Hu Peiqun, Hu Yushi
Sports Medicine Key Laboratory of Sichuan Province, Key Laboratory of Sports Medicine, General Administration of Sport of China, School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China.
Postdoctoral Workstation, Affiliated Sport Hospital of Chengdu Sport University, Chengdu, China.
Brain Behav. 2025 Sep;15(9):e70826. doi: 10.1002/brb3.70826.
Poststroke dysphagia impairs patients' quality of life and survival. Motor imagery (MI) is increasingly used as a rehabilitation adjunct, but its efficacy requires validation. This study aims to evaluate MI's effectiveness in treating poststroke dysphagia.
An extensive literature search was conducted across eight English and Chinese electronic databases (from inception to April 2025) to identify randomized controlled trials (RCTs) comparing the effects of MI combined with conventional therapy (experimental group) versus conventional therapy alone (control group) on poststroke dysphagia. The methodological rigor was assessed using the Cochrane Collaboration Risk of Bias Tool. Data analysis of the outcome measures was conducted using RevMan 5.3 software, with bootstrapped analysis to test the accuracy of primary outcomes.
Pooled analysis of 13 RCTs involving 1053 patients with poststroke dysphagia demonstrated that, compared to the control group, the MI supplementation group showed significantly lower water swallowing test scores (MD: -0.64, 95% CI: -0.76, -0.51, p < 0.00001) and standardized swallowing assessment scores (MD: -2.26, 95% CI: -2.94, -1.57, p < 0.00001) and higher swallowing quality of life scores (MD: 22.03, 95% CI: 7.25, 36.81, p = 0.003). Bootstrapping analysis substantiated the precision of these results. Furthermore, the meta-analysis revealed that add-on MI therapy significantly reduced the incidence of aspiration pneumonia (RR: 0.25, 95% CI: 0.12, 0.53, p = 0.0003) and increased clinical efficacy (RR: 1.23, 95% CI: 1.08, 1.39, p = 0.001). However, no significant effects were observed on aspiration incidence, malnutrition, or nasogastric tube removal rates.
Our findings support that MI therapy can be implemented as an add-on approach for poststroke dysphagia. More high-quality RCTs from multicenters are needed to provide more reliable evidence and explore the optimal treatment protocol.
中风后吞咽困难会损害患者的生活质量和生存率。运动想象（MI）越来越多地被用作康复辅助手段，但其疗效需要验证。本研究旨在评估运动想象对中风后吞咽困难的治疗效果。
在八个英文和中文电子数据库（从创建到2025年4月）中进行了广泛的文献检索，以确定比较运动想象联合传统疗法（实验组）与单纯传统疗法（对照组）对中风后吞咽困难影响的随机对照试验（RCT）。使用Cochrane协作偏倚风险工具评估方法的严谨性。使用RevMan 5.3软件对结局指标进行数据分析，并进行自抽样分析以检验主要结局的准确性。
对13项涉及1053例中风后吞咽困难患者的随机对照试验进行汇总分析表明，与对照组相比，运动想象补充组的饮水吞咽测试得分显著更低（MD：-0.64，95%CI：-0.76，-0.51，p<0.00001），标准化吞咽评估得分也更低（MD：-2.26，95%CI：-2.94，-1.57，p<0.00001），而吞咽生活质量得分更高（MD：22.03，95%CI：7.25，36.81，p=0.003）。自抽样分析证实了这些结果的准确性。此外，荟萃分析显示，附加运动想象疗法显著降低了吸入性肺炎的发生率（RR：0.25，95%CI：0.12，0.53，p=0.0003），并提高了临床疗效（RR：1.23，95%CI：1.08，1.39，p=0.001）。然而，在误吸发生率、营养不良或鼻胃管拔除率方面未观察到显著影响。
我们的研究结果支持运动想象疗法可作为中风后吞咽困难的附加治疗方法。需要更多来自多中心的高质量随机对照试验来提供更可靠的证据，并探索最佳治疗方案。
